Collecting stem cells from your blood: Information for people with autoimmune conditions, including multiple sclerosis (MS) and scleroderma

Stem cells are blood cells at a very early stage of development. They can divide and develop into three main types of blood cells: 

• Red blood cells, which carry oxygen to all cells in the body 
• White blood cells, which help fight infections caused by bacteria and viruses 
• Platelets, which help blood to clot and prevent bleeding. 

Stem cells are formed and develop into blood cells in the bone marrow, which is spongy tissue inside the bones. Once the blood cells are fully mature, they are released into the bloodstream from the bone marrow. A very small number of stem cells are also released and can be found in the blood. 

To collect your stem cells we need to move them from the bone marrow into your blood. This process is called peripheral blood mobilisation and we will refer to it as mobilisation. Once the stem cells are in the blood, we will use a procedure called apheresis to collect (harvest) them. Apheresis means removal or extraction. 

We want to collect your stem cells to protect them before your treatment.  

One of the treatment options available to you in the future is high- dose chemotherapy. This treatment aims to destroy the cells causing your autoimmune condition. But it also damages healthy stem cells, which are important for making blood cells. 

When the stem cells are damaged, your blood cell levels drop. This can make you prone to infections, bleeding or anaemia. It can also take a long time for your bone marrow to recover and start making blood cells again.  

By collecting some of your stem cells now, we can rescue them from being damaged. We can then return them to you through a drip a day or two after your chemotherapy. The stem cells go to your bone marrow and start to develop into healthy blood cells. This process is called an autologous stem cell transplant, or autograft. For more information about the transplant, visit our web page ‘A guide to autologous stem cell transplant: Information for people with autoimmune conditions, including multiple sclerosis (MS) and scleroderma'. 

Once you and your consultant decide to go ahead with high-dose treatment, a stem cell transplant clinical nurse specialist (CNS) will organise your stem cell collection. This will include arranging any tests or treatment you may need beforehand. 

The CNS will explain the process step by step and answer your questions. They will also give you a contact number in case you have questions or problems later. 

The CNS will talk to you about: 

• Tests needed before collection 
• Giving your consent for the treatment 
• Any treatment you may need before the collection, including a dental check-up 
• Preparing your stem cells for collection (mobilisation) 
• Blood tests during mobilisation, if needed  
• Assessing your veins 
• How your stem cells will be collected and stored 
• Fertility and contraception. 

After all tests are done or scheduled, you will get a timetable with all the steps you need to complete before and during mobilisation. This will also include provisional dates for collecting your stem cells. 

Let your CNS know if: 

• You are taking medicines that thin your blood 
• You have had radiotherapy before.

You will have various tests to make sure you are healthy enough for the 

stem cell mobilisation and collection.  

You will have several blood tests. These include tests for:

• Full blood count – to check your haemoglobin, white blood cells and platelets 
• Liver and kidney function 
• Blood type 
• Viruses, inlcuding Hepatitis B, Hepatitis C, HIV, syphilis and HTLV.  

In the UK, the law requires to check for viral infections before collecting and storing stem cells. This helps to prevent infection from spreading to healthy cells during storage. By doing these tests we are not implying that you have these viruses. 

You will also have re-staging scans (where relevant):

Re-staging scans, such as PET, CT or MRI, check how well your recent treatment is working.

Your hospital doctor and stem cell transplant CNS will ask you to sign a consent form for stem cell mobilisation and collection. This will confirm that you agree to have the procedure and understand what it involves. If you have any questions or are unsure about anything, please ask – they are there to help.

We mobilise the stem cells by combining chemotherapy and injections of growth factor G-CSF. G-CSF stimulates the growth of stem cells in the bone marrow and helps to release them into your bloodstream. 

• Chemotherapy: First, you will receive a single dose of cyclophosphamide chemotherapy through a drip. This takes a couple of hours and is done in a daycare setting. You will also receive fluids through another drip. The whole process takes about six hours to complete.  
• G-CSF injections: The day after chemotherapy, you will start a course of G-CSF injections to help your body produce more stem cells. You will administer these injections yourself, and your healthcare team will tell you how long the course is.  

Together, chemotherapy and G-CSF injections cause your body to make extra stem cells. These stem cells will move from your bone marrow into your bloodstream as your white blood cell count recovers. Once this happens, the stem cells can be collected (harvested).

G-CSF is a natural substance your body makes to help turn stem cells in your bone marrow into mature blood cells. When given at higher doses than your body makes, G-CSF also moves some of your stem cells from the bone marrow into your bloodstream. 

After a number of G-CSF injections, your white blood cell count will rise and stem cells will move (mobilise) into your bloodstream.  

It’s very important that you do not miss any of your G-CSF injections. Missing a dose can lower the number of stem cells in your blood. This can make it harder to collect enough for your treatment. 

Are there any side effects of G-CSF injections?

Yes, there are some side effects of G-CSF injections, with the most 

common ones including: 

• Back pain 
• Flu-like symptoms 
• Headaches. 

These are temporary and will get better once you finish your course of injections. Paracetamol tablets (two tablets = 1g) should help to ease these symptoms. You can take a maximum of eight tablets (4g) 

in 24 hours. This is two tablets every six hours. If paracetamol is not helping, you can try co-codamol. This is a mix of paracetamol and codeine, and you can get it in any pharmacy. If co-codamol doesn’t relieve your pain or your symptoms get worse, contact the stem cell transplant CNS for advice. 

Do not take aspirin, or medicines that contain or are similar to aspirin (such as ibuprofen), while you are having G-CSF injections. If you take aspirin for medical reasons, please tell your CNS. 

Very rarely an allergic reaction can occur. Go to your local Emergency Department (A&E) without delay if you experience any of the symptoms listed below: 

• Itching 
• Rash 
• Rapid heart rate 
• Dizziness 
• Shortness of breath. 

A serious but extremely rare complication of G-CSF is spleen enlargement and rupture. If you experience any tenderness in the upper left side of your abdomen, just underneath your rib cage, go to your local Emergency Department (A&E) straight away. You should also contact us on 07852 220900. 

How is the G-CSF given?

The G-CSF injections are given under the skin, usually in the abdomen, thighs or upper arms. You can do the injections yourself at home. Or they can be administered by: 

• A family member 
• A district nurse 
• A nurse at your local hospital or at UCLH. 

If you or your family member want to administer the injections, a nurse will show you how to do them.  

You will need to keep the injections in the fridge and use them at the same time each day. Taking the injection out of the fridge 20 minutes before using it can help reduce stinging.

• Your stem cell collection will take place in the Apheresis Unit, 4th Floor University College Hospital Macmillan Cancer Centre. You will need to arrive to the Apheresis Unit at 8.30am. 
• First, you will have a blood test to check your blood counts. If your blood counts are not at a required level, you will need to go home to have another injection of G-CSF. We will ask you to return the next day for a blood test. 
• We will collect your stem cells using a procedure called apheresis. During apheresis, a constant flow of blood is taken from the bloodstream and passed through a machine called a ‘cell separator’. The cell separator separates out the stem cells and puts the remaining blood components back into your bloodstream. 
• An apheresis nurse (a nurse who will carry out the collection) will assess the veins in your arms. This is to make sure they are suitable for the stem cell collection.  
• If your veins are suitable, you will have two needles. We will insert a larger needle in your non-dominant arm (the arm that you don’t write with), if possible, and a smaller needle in the other arm. During the collection, blood will be taken from the larger needle into the cell separator. The cell separator will separate the blood into the different types of blood cells and collect the stem cells into a collection bag. The rest of your blood will then be returned to you via the smaller needle in the other arm. 
• If your veins are not suitable, we will insert a special tube called a vascath into a large vein near the top of your leg (in the groin area). This thin, flexible tube will help to take blood out and return it to your bloodstream in a continuous flow. You will have a local anaesthetic (pain relief) to have the vascath inserted. The tube will stay in place until we collect enough stem cells. We usually collect enough in one day. If we don’t, you will need to stay in hospital overnight with the vascath in place. 

Preparing the cell separator

An apheresis nurse will prepare the cell separator for the collection and stay with you throughout the procedure. The collection will last about four to five hours. You will need to stay fairly still on a reclining bed during this time. 

The nurse will fit a sterile kit into the cell separator so that your blood is not exposed to outside infections during the collection. 

Once the two lines from the kit are attached to you, the nurse will enter your height, weight and your morning blood test results into the cell separator control panel. Then the stem cell collection can begin. 

How much blood will be in the cell separator?

The amount of blood in the cell separator at any time is less than 250ml (less than a small glass of water). The amount of blood cells taken from you by the end of the procedure will be about 200ml. 

Beginning the stem cell collection

As the blood enters the cell separator, a drug called ACD-A is added to it. ACD-A stops the blood from clotting while it is going through the cell separator. 

Are there any side effects that can occur during the collection?

Yes, the most common side effects are caused by ACD-A. 

What side effects does ACD-A cause?

You may feel sick or you may have some tingling in your lips and nose or fingertips. These side effects are short-lasting and should stop once you have some calcium supplements, like chewable tablets or an infusion. 

If you experience any of these side effects, tell your nurse straight away. They will help to relieve these symptoms very quickly. It may also be a good idea to have a milky breakfast before the collection. 

Why does ACD-A cause side effects?

The blood would naturally clot within the cell separator. As calcium helps the blood to form clots, ACD-A is used to absorb the calcium from the bloodstream and prevent the blood from clotting. This lowers the calcium levels in the blood and may cause side effects. 

What other side effects or problems can occur?

As your blood pressure drops during the collection, you may feel light-headed, especially at the beginning. Please tell your nurse if you experience this. 

It’s also sometimes difficult to get enough blood to flow from the veins in your arm. Your apheresis nurse may need to adjust the position of the needle to allow a better flow. This should not be painful but please tell the nurse if you feel any discomfort. 

What can I do during the collection?

• You will need to remain in bed or seated for the entire time the collection takes (four to five hours).  
• Wear loose-fitting clothes so you are comfortable during that time. 
• Bring something that can help you pass the time, for example a book or a tablet.  
• You will be able to eat and drink so feel free to bring some snacks. 
• One visitor will be able to stay with you during the collection. 
• If you wish to use the toilet, a nurse can help you to use a commode or urine bottle by the bedside. 

What happens when the collection has finished?

Your apheresis nurse will disconnect you from the cell separator and take the stem cells to the laboratory. You will have some blood tests before you can get up and move around. 

Your stem cells will be counted in the laboratory to check if we have enough. This takes about one hour. You will need to wait in the Apheresis Unit until the results are ready. 

Most people collect enough stem cells in one day and can go home. If you had a vascath inserted, the nurse will remove it before you leave. 

If we don’t collect enough cells, you may need another collection the next day. In this case, if you have a vascath, you will need to stay in the hospital overnight.

The cells are frozen (cryopreserved) in the laboratory until you need them for your treatment, or until they can be disposed of. 

What happens if the stem cells are not used in a transplant?

There are a few possible reasons why the stem cells may not be used for a transplant: 

• There may not be enough cells for the transplant. 
• The cells may not be suitable (for example, if they have an infection). 
• A medical reason may stop the transplant from going ahead as planned. 

Stem cells that are safe and infection-free will be frozen and stored at UCLH, usually for up to five years. They may be stored for less time if they are no longer needed or unsuitable. 

After five years, the cells may be disposed of after the relevant consultant(s) have reviewed your records. Disposal will follow strict national and EU regulations. 

If your cells are still safe to use after that time, you may transfer them to another storage facility outside of UCLH. During the consent process, you can tell us if you want to be contacted about this. Please keep us updated with your current address and phone number.

If the collected stem cells have a potentially contagious infection, they will be stored separately for at least 12 weeks. After that, they may be disposed of if they are no longer needed or are not suitable for use. This will follow the same process described above.

MS Society 

Tel: 0808 800 8000 

Website: mssociety.org.uk 

Scleroderma and Raynaud’s UK 

Tel: 020 3893 5998 

Email: info@sruk.co.uk 

Website: sruk.co.uk 

Anthony Nolan 

Tel: 0303 303 0303 

Email: patientinfo@anthonynolan.org 

Website: anthonynolan.org 

University College London Hospitals NHS Foundation Trust cannot accept responsibility for information provided by external organisations.

Stem cell transplant CNSs  

Tel: 07538 702196 (Monday to Friday, 9am to 5pm) 

Please leave a message if no one is available to answer your call. We will call you back as soon as we can. 

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